Editor's note: For the latest news on coronavirus disease 2019, visit https://www.aappublications.org/news/2020/01/28/coronavirus.
U.S. health officials have updated guidance on personal protective equipment for health care personnel amid the spread of SARS-CoV-2, which the World Health Organization declared a pandemic on Wednesday.
The Centers for Disease Control and Prevention (CDC) guidance includes new recommendations on face masks, gowns, and airborne infection isolation rooms and is available at http://bit.ly/2ICA4Hv.
“This now provides a little relief, I think, for providers who were having a very difficult time reconciling the difference between what they have and what they were being advised to do as well as … lower the anxiety level in your average practice,” said Steven E. Krug, M.D., FAAP, chair of the AAP Council on Disaster Preparedness and Recovery.
SARS-CoV-2, which causes coronavirus disease 2019 (COVID-19), is spread primarily via respiratory droplets. When entering a patient’s room, health care personnel can use a face mask if an N95 respirator isn’t available, according to the CDC. However, N95 or higher-level respirators should be used during aerosol-generating procedures, such as sputum induction or open suctioning of airways. They also should be worn when collecting respiratory specimens, although face masks are acceptable during this procedure if necessary.
The CDC continues to recommend health care personnel wear gowns, gloves and eye protection (goggles or face shields, not personal eyeglasses or contacts) when caring for patients with suspected or confirmed cases of COVID-19.
“If there are shortages of gowns, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of HCP (health care personnel),” according to the CDC guidance.
High-contact patient care activities include dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use and wound care.
David W. Kimberlin, M.D., FAAP, editor of AAP Red Book,said protection also should be used when coming in contact with surfaces the patient has been near or directly contacted.
The CDC also has updated guidance on airborne infection isolation rooms, more commonly known as negative pressure rooms, saying they should be reserved for patients undergoing aerosol-generating procedures. Other hospitalized patients with suspected or confirmed COVID-19 should be placed in a single-person room with the door closed and a dedicated bathroom.
Health care personnel collecting diagnostic specimens can do so in a normal examination room with the door closed while wearing an N95 or higher-level respirator (or a face mask if respirators are not available), eye protection, gloves and a gown, according to the CDC.
Dr. Kimberlin said the CDC guidance is reasonable, given some health care personnel don’t have access to a large supply of personal protective equipment.
“We are in catch-up mode right now and preparing for what is likely to be major stress to the national health care system,” he said. “And so, getting ready for that and prioritizing how to use what is a limited resource, personal protective equipment, is what this is trying to get at.”
Dr. Krug also noted children do not need to be sent to an emergency department (ED) for testing unless they are seriously ill. If a clinician does refer a patient to an ED, call ahead so the facility can prepare.